Dr. Smith's research focuses primarily on immunology and transplantation, with emphasis on the transplantation pathology of the heart, kidney, and pancreatic islets. He is particularly interested in how the acute and chronic rejection of allografts and xenografts comes about. Studies involve patients and animal experimentation of heart, kidney, lung, and pancreatic islet grafts. With expertise in these areas, Dr. Smith is a consultant pathologist to investigators within the Harvard community, and to national consortia with clinical transplant programs. Dr. Smith is also a consultant to revisions of the classification scheme for human heart allograft biopsies.

Dr. Smith teaches cardiovascular, renal,and autopsy pathology to Harvard Medical Students and MGH physicians. He teaches in renal pathology at the Harvard-MIT Division of Health, Science, and Technology and Module II at Harvard School.

Rex Neal Smith

Patricia Della Pelle

Nicole Brousaides

Current emphasis and ongoing work includes cellular and humoral rejection in humans (hearts) and monkeys (kidneys). Dr. Smith has been able to correlate in direct immunofluorescence C4d staining with alloantibodies by retrospective and prospective analysis of the cardiac allograft biopsies. This study establishes for the first time the correlation between C4d staining and the presence of alloantibodies. The Immunopathology laboratory is a reference site for this test.

Dr. Smith is also studying the progression of monkey kidney allograft rejection that comes about with development of alloantibodies and has established that alloantibodies strongly associate with and are likely causative of the glomerulopathy of chronic humoral rejection in allografted kidneys, thereby, establishing that chronic humoral rejection develops through stages.